Research progress of the local treatments on choroidal metastasis of lung cancer / 上海交通大学学报（医学版）

The choroid is one of the most common ocular sites for metastatic disease. Lung cancer is the first cause of choroidal metastasis among primary cancers in China. The current management of choroidal metastasis of lung cancer is based on the combination of systemic treatments and local treatments. The latter mainly include radiotherapy, transpupillary thermotherapy, photodynamic therapy, intravitreous injection and enucleation. This review covers the research progress in local treatments on choroidal metastasis of lung cancer.

Research progress of the local treatments on choroidal metastasis of lung cancer / 上海交通大学学报（医学版）

The choroid is one of the most common ocular sites for metastatic disease.Lung cancer is the first cause of choroidal metastasis among primary cancers in China.The current management of ehoroidal metastasis of lung cancer is based on the combination of systemic treatments and local treatments.The latter mainly include radiotherapy,transpupillary thermotherapy,photodynamic therapy,intravitreous injection and enucleation.This review covers the research progress in local treatments on choroidal metastasis of lung cancer.

Pérdida de la agudeza visual como primera manifestación del cáncer de páncreas: Reporte de caso / Visual acuity loss as first manifestation of pancreatic cancer: Case report

Las metástasis oculares constituyen el tumor maligno intraocular más frecuente en la población adulta. Estas tienen en su mayoría un compromiso coroideo. Se describe el caso de una paciente que presentó disminución de la agudeza visual rápidamente progresiva en el ojo derecho. Sin antecedentes personales relevantes, durante la evaluación oftalmológica se observa una lesión coroidea, la cual clínica y radiológicamente sugería una metástasis coroidea como primera impresión diagnóstica. Posterior a la realización de estudios de extensión se confirmó histopatológicamente un tumor pancreático como origen de la metástasis. Las metástasis oculares ocasionadas por el páncreas son extremadamente raras, lo cual se confirma en la revisión de la literatura realizada.

The ocular metastases are the most common intraocular malignant tumor in the adult population. These have mostly a choroid commitment. This case report describes a female patient who presented with a rapidly progressive decrease in visual acuity in the right eye, no other symptoms were referred and her medical history was no relevant. A choroidal lesion was found, which clinically and radiologically suggested a choroid metastasis as the diagnosis. With extension studies was confi rmed histopathologically a pancreatic tumor as the primary tumor. The ocular metastases that are originated for the pancreas are extremely rare; this is confirmed by the review of the literature.

FFA and ICGA imaging analysis of choroidal metastatic carcinoma / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To compare the imaging features of fundus fluorescein angiography(FFA)and indocyanine green angiography(ICGA)in choroidal metastases, and to provide the basis for the accurate diagnosis of choroidal metastases.<p>METHODS: Six patients(8 eyes)with definite primary malignant tumor lesion were diagnosed, and fundus photographs were taken after mydriasis. FFA and ICGA were simultaneously contrasted with Heidelberg fundus angiography to compare the similarities and differences between the two imaging examinations. <p>RESULTS: FFA showed a low fluorescence at the early stage, a needle-like or spot-like fluorescence at the middle stage and a strong fluorescence band at the late stage, and a weak fluorescence at the edge of the lesion in some cases. The ICGA showed a low fluorescence. There was no significant change in intensity, only 1 case in the reverse phase of the central and focal lesions around the strong fluorescence. <p>CONCLUSION: FFA and ICGA for choroidal metastases have a more characteristic performance, both helpful for the diagnosis of choroidal metastases.

The effect of intravitreal bevacizumab and transpupillary thermotherapy on choroidal metastases and literature review.

Aims: To represent the effects of transpupillary thermotherapy (TTT) and intravitreal bevacizumab on choroidal metastases and review the literature. Settings and Design: A retrospective, interventional, noncomparative case series. Materials and Methods: A retrospective, interventional, noncomparative case series of five eyes in three patients with choroidal metastases was conducted. Fundus findings of choroidal metastases were divided into two types: Solitary or diffuse type. The size of the tumor was termed small (<10 mm diameter), medium (10–15 mm diameter) or large (>15 mm diameter). All eyes received one session of TTT followed by 3 weekly intravitreal bevacizumab injections as an adjuvant therapy. The parameters of treatment for TTT were 1.2–3 mm spot size, 150–300 mW, 60 s with the whole lesion covered confluently. The changes in preoperative and postoperative best‑corrected visual acuity (BCVA) were recorded. Serial color fundus photography and optical coherent tomography were performed to measure the treatment efficacy. Results: All eight choroidal metastases were solitary type. The size of six tumors was small, the size of one tumor was medium, and the size of one tumor was large. All five eyes of the three patients had improvement of BCVA after treatment. Fundus photos revealed tumor shrinkage and the mean shrinkage percentage was 61.27 ± 21.71%. Optical coherence tomography revealed complete resolution of serous retinal detachment. There was no recurrence after 6 months follow‑up. Conclusions: TTT combined with intravitreal bevacizumab injections brought about beneficial effects in reducing tumor size and improving vision in all five eyes of the three patients. Despite the retrospective nature of our study, the absence of control group and the size limitation that, of course, limit the statistical power, TTT combined with intravitreal bevacizumab seems to be efficient in providing another cost‑reducing and time‑saving treatment option for patients with choroidal metastases. The antineoplastic properties of bevacizumab make it a viable adjunctive therapy. Studies with more cases and a longer follow‑up period are warranted.

Metástasis oculares de carcinoma mamario. Reporte de casos / Intraocular metastasis from breast carcinoma. Cases report

Objetivo: reportar los casos de dos pacientes con metástasis coroideas y a nervio óptico secundarias a carcinoma ductal infiltrante mamario y revisar la literatura al respecto. Diseño del estudio: estudio observacional descriptivo, tipo serie de casos. Metodología: se reporta el caso de dos pacientes con diagnóstico de metástasis coroidea y a nervio óptico secundarias a carcinoma mamario que consultaron a la Liga de Lucha Contra el Cáncer en Barranquilla ­ Colombia en Enero del 2015 y a la Clínica Unidad Láser del Atlántico en Agosto de 2014. Se hizo revisión detallada de la historia clínica, se tomaron fotos a color, angiografía con fluoresceína de la retina, ecografía y tomografía óptica coherente de mácula y nervio óptico Resultados: Serie de dos casos de metástasis oculares de carcinoma mamario. Mujeres de 41 y 52 años con diagnóstico conocido de carcinoma mamario que requirió mastectomía radical y quimioterapia sistémica. Los estudios de angiografía y ecografía confirmaron la impresión diagnóstica clínica de metástasis intraocular. Conclusión: los tumores metastásicos son las neoplasias malignas intraoculares más comunes en el adulto y la coroides es el lugar más frecuente donde ocurren, siendo las metástasis a nervio óptico un evento infrecuente. Se recomienda una evaluación periódica por retina y un alto índice de sospecha diagnóstica en aquellos pacientes con diagnóstico conocido de carcinoma mamario con o sin metástasis sistémicas asociadas, que inician con síntomas visuales. En estos casos las pruebas auxiliares como ecografía modo B y angiografía son herramientas útiles para apoyar el diagnóstico.

Objective: to report two cases of choroidal and optic nerve metastases from breast carcinoma and review the literature. Design: cases reports. Methods: We performed a descriptive case report with detailed review of the medical records of two patients with intraocular metastasis from breast carcinoma. Their medical records were reviewed and analyzed. Ultrasonography, fluorescein angiography and optic coherence tomography were taken. Results: We report a series of two women 41 and 52 years old with a previous diagnosis of infiltrating ductal carcinoma that required radical mastectomy and systemic chemotherapy. Angiography and ultrasound studies confirmed the clinical diagnosis of intraocular metastases. Conclusions: metastatic carcinomas are the most common forms of adult intraocular tumors and the choroid is the most frequent site where they occur. Metastases to the optic nerve head are rare event. Periodic visits to the retina specialist and a high index of suspicion in patients with visual symptoms and diagnosis of breast carcinoma with or without associated systemic metastasis are recommended. Angiography and ultrasonography are important ancillary tools.

Pigmented Choroidal Metastases Masquerading as Choroidal Melanoma

PURPOSE: To report the first case of pigmented choroidal metastases without enucleation diagnosed with fine-needle aspiration biopsy. CASE SUMMARY: A 47-year-old male was referred to our clinic with a suspected diagnosis of choroidal melanoma in his left eye. Positron emission tomography-computer tomography used to evaluate systemic metastases revealed lung cancer. Pathology of the detected lung mass was primary lung neuroendocrine tumor. To differentiate choroidal metastasis and primary choroidal melanoma, we performed a fine-needle aspiration biopsy for choroidal tumors. The cytology showed results favoring metastatic atypical carcinoid and the patient was started on systemic chemotherapy. CONCLUSIONS: All pigmented choroidal tumors are not choroidal melanomas and choroidal metastases may be pigmented. The present case suggests that proper systemic evaluation and biopsy for suspected choroidal tumor could be helpful in diagnosis.

Morphological features of choroidal metastases: An OCT analysis.

The morphological characteristics and retinal changes of chroidal metastases using Spectral Domain OCT are described in a case with primary lung adenocarcinoma and secondary choroidal involvement.

Metástasis coroidea de cáncer pulmonar: reporte de un caso / Choroidal metastasis from lung cancer: case report

Introducción: El compromiso ocular en el cáncer sistémico es diverso y ampliamente conocido en la literatura internacional, pero en la nacional hay carencia de información al respecto. La coroides es la estructura ocular donde con mayor frecuencia se encuentran metástasis tumorales dentro del ojo, siendo el cáncer de pulmón el más comúnmente diagnosticado en pacientes que debutan con metástasis coroidea. En esta localización, los síntomas más frecuentes son la visión borrosa y dolor ocular, siendo la presentación asintomática infrecuente. Este tipo de lesiones se produce en la fase final de la enfermedad, donde la supervivencia no supera los 6 meses. Presentación del caso: Paciente portador de cáncer pulmonar, que debutó con metástasis coroidea, siendo la primera sintomatología compatible con desprendimiento de retina. Las claves para el diagnóstico fueron la ultrasonografía ocular, resonancia nuclear magnética, y la biopsia realizada tras la enucleación del ojo afectado que es informada como adenocarcinoma tubular y papilar. De acuerdo a este resultado, se estudia con tomografía computada (TAC) de tórax, abdomen y pelvis, cintigrama óseo, revelándose la imagen de un nódulo pulmonar sospechoso y metástasis pulmonares y extrapulmonares. Tras 8 meses desde el hallazgo de la metástasis coroidea, y 6 meses desde el diagnóstico de cáncer pulmonar, el paciente fallece. Finalmente, se revisó la bibliografía pertinente acerca de la clínica, aproximación diagnóstica, imágenes y consideraciones sobre el tratamiento de las metástasis coroideas. Discusión: Es importante conocer la aproximación diagnóstica de las metástasis coroideas de tumores primarios para tener un alto índice de sospecha.

Introduction: Ocular involvement in systemic cancer is diverse and widely known in the international literature, but in our country there is lack of information. The choroid is the structure of the eye where they most often metastatic tumor within the eye are found, being lung cancer the most commonly diagnosed in patients presenting with choroidal metastasis. At this location, the most common symptoms are blurred vision and eye pain. Asymptomatic presentation is uncommon. This type of injury occurs in the final stage of the disease, where survival does not exceed 6 months. Case report: Patient with lung cancer, which debuted with choroidal metastasis, whose first symptoms consistent in retinal detachment. The keys to diagnosis were ocular ultrasonography, magnetic resonance imaging, and biopsy performed after enucleation of the affected eye, which was reported as tubular and papillary adenocarcinoma. According to this result, he was studied with chest, abdomen and pelvis CT, bone scintigraphy, revealing the image of a suspicious lung nodule and pulmonary and extrapulmonary metastases. After 8months since the finding of choroidal metastases, and 6 months after diagnosis of lung cancer, the patient dies. Reviewed the relevant literature on the clinical diagnostic approach, images and considerations on the treatment of choroidal metastases. Discussion: It is important to know the approach to diagnosis of choroidal metastases from primary tumors to have a high index of suspicion.